Robert E Wallace

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

25-QMHP-R-3536 Issued in OR

Practice address

93463 Alabama LN
Coos Bay, OR 97420-3977

Phone

(660) 525-6182

NPI assigned

Jul 21, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753056000000",
    "number": "1679455703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 653",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974200124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93463 ALABAMA LN",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974203977",
            "telephone_number": "660-525-6182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ROBERT",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-21",
        "last_updated": "2025-07-21",
        "certification_date": "2025-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "25-QMHP-R-3536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James M. Wahl
• Wal-Mart Stores Inc
• Krystal Cathleen Walden
• Bryan Charles Walker, RPH
• Michaela Walker, DDS
• Candace Nicole Wallis
• Walmart Inc.
• Walmart, Inc.
• Tasha Anne Walter, CADC 1, CRM, PSS
• Ronni Waltz, PSS

• Mental Health Counselor in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.